GLADIATOR: Evaluation of GeranylGeranylAcetone in Heart Failure With Preserved Ejection Fraction
Study Details
Study Description
Brief Summary
The goal of this double-blind randomized, placebo-controlled cross-over trial is to evaluate the effectiveness of GerenylGeranylAcetone (GGA) in patients with Heart Failure with a preserved ejection fraction.
The main questions it aims to answer are:
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What is the effect of GGA on diastolic function?
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What is the effect of GGA on endothelial function?
Main study tasks:
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Participants will be treated with either GGA or placebo for 13 weeks. After this they will have a break (wash-out) period for 6 weeks and then cross over to the other study arm.
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Cardiac function will be measured using echocardiogram in all participants
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Renal measurements and endothelial measurements will be performed on the participants.
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Participants will perform a 5 minute walking distance test for functional capacity.
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Participants will fill out questionnaires to score signs & symptoms.
Researchers will compare the patients to themselves to see if the drug improves diastolic- and endothelial function.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Experimental arm Patients will receive 13 weeks of experimental treatment, followed by a 7 week wash-out period, continuing with 13 weeks of placebo as per crossover design. |
Diagnostic Test: Iohexol measurement
Invasive renal hemodynamic measurement of mGFR through the administration of Iohexol.
Drug: Geranylgeranylacetone (GGA)
13 weeks of treatment with GGA/placebo orally, followed by a wash-out period of 6 weeks, then reversal of the treatment arms.
Diagnostic Test: Echocardiography
The investigators will perform echocardiography to find changes in cardiac function.
Diagnostic Test: 6-minute walking distance test
6 minute walking distance test to compare exercise tolerance in participants.
Diagnostic Test: EndoPAT
Use of EndoPAT to measure endothelial function.
Diagnostic Test: Para-amino Hippuric Acid test
PAH-measurement to measure ERPF.
Diagnostic Test: Electrocardiogram
12-lead Electrocardiogram
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Placebo Comparator: Placebo arm Patients will receive 13 weeks of placebo treatment, followed by a 7 week wash-out period, continuing with 13 weeks of experimental treatment as per crossover design. |
Diagnostic Test: Iohexol measurement
Invasive renal hemodynamic measurement of mGFR through the administration of Iohexol.
Drug: Geranylgeranylacetone (GGA)
13 weeks of treatment with GGA/placebo orally, followed by a wash-out period of 6 weeks, then reversal of the treatment arms.
Diagnostic Test: Echocardiography
The investigators will perform echocardiography to find changes in cardiac function.
Diagnostic Test: 6-minute walking distance test
6 minute walking distance test to compare exercise tolerance in participants.
Diagnostic Test: EndoPAT
Use of EndoPAT to measure endothelial function.
Diagnostic Test: Para-amino Hippuric Acid test
PAH-measurement to measure ERPF.
Diagnostic Test: Electrocardiogram
12-lead Electrocardiogram
|
Outcome Measures
Primary Outcome Measures
- Filling pressures [after 13 weeks of treatment]
Changes in echocardiography determined filling pressures (E/e')?
- Endothelial function [after 13 weeks of treatment]
Changes in EndoPAT®-derived reactive hyperemia index (RHI)
Secondary Outcome Measures
- Left atrial volumes [After 13 weeks of treatment]
Changes in echogardiographic measured left atrial volume index (LAVI)
- Left atrial global strain [After 13 weeks of treatment]
Changes in echogardiographic measured LA global strain (LAGS)
- Left atrial emptying fractions [After 13 weeks of treatment.]
Changes in echogardiographic LA emptying fractions. Formula: (LA maximum volume-LA minimum volume)/LA maximum volume × 100%
- Left Ventricular global longitudinal strain [Ater 13 weeks of treatment]
Changes in echocardiographically determinded LV global longitudinal strain (LGS)
- Left Ventricular Myocardial relaxation [Ater 13 weeks of treatment]
Change in echocardiographically determined myocardial relaxation (e')
- Left Ventricular distensibility [After 13 weeks of treatment]
Change in echocardiographically determined LV distensibility, measured by E.
- Right Ventricular systolic function [After 13 weeks of treatment]
Change in echocardiographically determined RV TAPSE
- Pulmonary Artery Pressure [After 13 weeks of treatment]
Change in echocardiographically determined PAP
- Patient reported symptoms [After 13 weeks of treatment]
Evaluation of symptoms using New York Heart Association class (NYHA)
- Quality of life assessment [After 13 weeks of treatment.]
Evaluation of quality of life using the Kansas City Cariomyopathy Questionnaire
- Functional capacity [After 13 weeks of treatment.]
Evaluation of Functional Capacity using 6-minute walking distance test (6MWD)
- CRP (inflammatory biomarker) [After 13 weeks of treatment]
Changes in CRP concentration in serum
- Nitrosated hemoglobin (microvascular marker) [After 13 weeks of treatment]
Changes in Nitrosated hemoglobin (Hb(NO)4) concentration in serum
- Nitrate (microvascular marker) [After 13 weeks of treatment]
Changes in nitrate concentration in serum
- Endothelin-1 (microvascular marker) [After 13 weeks of treatment]
Changes in Endothelin-1 concentration in serum
- H2S (microvascular marker) [After 13 weeks of treatment]
Changes in H2S concentration in serum
- Measured Glomerular Filtration Rate (mGFR) [After 13 weeks of treatment]
Changes in mGFR using Iohexol measurements in urine
- Effective Renal Plasma Flow (ERPF) [After 13 weeks of treatment]
Changes in ERPF using PAH-measurements in urine
- Renal vascular resistance (RVR) [After 13 weeks of treatment]
Changes in intrakidney hemodynamic function (Systemic Blood pressure / Renal Blood Flow)
- Urine Albumine Creatinin Ratio [After 13 weeks of treatment]
Changes in UACR concentration measured in urine.
- Neutrophil gelatinase associated lipocalin (NGAL) [After 13 weeks of treatment]
Changes in NGAL concentration measured in urine and serum
- Kidney Injury marker 1 (KIM-1) [After 13 weeks of treatment]
Changes in KIM-1 concentration measured in urine and serum
Other Outcome Measures
- N-terminal pro Brain Natriuretic Peptide (NT-proBNP) [After 13 weeks of treatment]
Changes in NT-proBNP measured in serum
- Troponin T [After 13 weeks of treatment]
Changes in Troponin T measured in serum
- Clinical events [After 13 weeks of treatment]
Comparison of the frequency of a combined safety endpoint of death, myocardial infarction and heart failure hospitalization
- Serious Adverse Events (SAE's) [After 13 weeks of treatment.]
Comparison of the frequency of Serious Adverse Events between both groups.
- Treatment Emergent Adverse Events (TEAE's) [After 13 weeks of treatment.]
Comparison of the frequency of Treatment Emergent Adverse Events between both groups.
- Adverse events of specific interest (AESI's) [After 13 weeks of treatment]
Comparison of the frequency of Adverse events of specific interest between both groups.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age≥ 50 years
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Patients with a diagnosis of symptomatic chronic heart failure (New York Heart Association class II or III) AND preserved systolic LV function (LV ejection fraction or LVEF ≥ 50%) documented within the last 6 months AND evidence of diastolic LV dysfunction with at least 1 out of the following 4 criteria:
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HFA-PEFF score ≥5
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H2FPEF score ≥6
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HFpEF according to the 2021 ESC HF Guidelines (NT-proBNP>125 pg/ml AND either LV mass indexed or LVMI >95 g/m2 for women and >115 g/m2 for men OR left atrial volume indexed or LAVI >34 ml/m2 OR mean e; septal/lateral < 9 cm/s) OR E/e' >13 OR TR velocity at rest >2,8m/s.
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Pulmonary capillary wedge pressure (PCWP) >15 mmHg and/or >25 mmHg during exercise.
Exclusion Criteria:
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Current acute decompensated heart failure, requiring hospitalization or augmented therapy with intravenous diuretics, vasodilators, and/or inotropic drugs
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Acute coronary syndrome, transient ischemic attack/cerebrovascular accident, major surgery within the previous 3 months
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Hemoglobin <9 g/dl at screening
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LVEF <40% measured at any time point in the history of the patient
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History of mitral valve repair or replacement
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Presence of significant valvular disease defined as mitral valve regurgitation defined as grade ≥ 3+ MR; tricuspid valve regurgitation defined as grade ≥ 2+ TR; aortic valve disease defined as ≥ 2+ AR or > moderate AS
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Acute myocarditis within 3 months prior to randomization
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Infiltrative cardiomyopathy
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Genetic cardiomyopathy
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Severe pulmonary disease requiring home oxygen or chronic oral steroid therapy
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Precapillary pulmonary hypertension
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BMI >40 kg/m2
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Estimated glomerular filtration rate (GFR) <20 ml/min or >90 ml/min
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History of solid organ transplantation including kidney transplantation
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Atrial fibrillation or atrial flutter with resting ventricular rate >110 bpm
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Not able to undergo the complete study protocol
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Doubt about compliance
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Pre-menopausal women who are nursing, pregnant, or of child-bearing potential and not practicing an acceptable method of birth control
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Chronic absorption problems
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Proven allergy for lactose products or cow-milk.
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Proven allergy for Iodide-containing contrast, Iohexol or PAH.
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Any documented or suspected malignancy or history of malignancy within 1 year prior to screening, except appropriately treated basal cell carcinoma of the skin or in situ carcinoma of the cervix
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Currently enrolled in another investigational device or drug trial
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Estimated life expectancy <1 year
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Amsterdam UMC, location VUmc
Investigators
- Principal Investigator: Louis Handoko, MD, PhD, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
- Principal Investigator: Adriaan Voors, MD, PhD, University Medical Center Groningen
- Principal Investigator: Loek van Heerebeek, MD, PhD, Onze Lieve Vrouwe Gasthuis, Amsterdam
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- NL 80684